acce ce presentation material

8/16/2019 ACCE CE Presentation Material

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CAVEAT EMPTOR:Decision Making on Clinical Technology Acquisitions

Wednesday, April 15 – 11:30am-12:30pm

Stephen L. Grimes, FACCE FAIMBE FHMISS

Chief Technology Officer,

ABM Healthcare Support Services

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Jacob B Johnson, MS CCE

Manager, Clinical Technology Integrated Systems Management

Kaiser Permanente


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Conflict of Interest

Stephen L. Grimes, FACCE FAIMBE FHIMSS

Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Jacob B. Johnson, MS CCE

Has no real or apparent conflicts of interest to report.


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Session Description

Capital budgets for clinical technology acquisitions today is often 8 to

10 times larger than what same organization spent 10 years ago.

This session provides a description of a structure, process, and tools

that decision makers (CEOs, COOs and CFOs) should avail themselves

of when determining which clinical technologies to adopt and how tomeasure a successful implementation.


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Learning Objectives

1) Explain why the challenge of clinical technology acquisitions today

represents a major shift from acquisitions of only a few years ago

2) Identify best sources of objective information that decision makers

should typically consult before selecting and deploying new clinical

technologies

3) Describe a scalable structure, process, and set of tools that facilitates

the smart selection and adoption of new clinical technologies

4) Describe how to establish key objectives related new clinical

technologies under consideration and how to assess the level of

success achieved following deployment


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Today’s Challenge

trend in annual spend for biotech and related purchases (as reported

by CEO of KP) for One Health Plan has increased > 9 times ($62.3M

to $580M) between 1997 and 2007 … and that trend is likely to

continue rising for healthcare organizations

implementation of new medical technology accounts for between 38

percent and 65 percent of health care spending increases between

1985 and 2006.‡

rapid evolution of new and complex technologies (e.g., hybrid ORs,

radiosurgical systems, robotic surgical systems, 3D imaging, real-time

vital sign monitoring for general patient population, etc.) poses

significant challenges for organizations who strive to adopt

technologies that both broaden and improve patient care services

while better managing costs

Source: Halverson, George C., “Healthcare will not reform itself.” CRC Press. 2009. pg 22

‡ Source: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf71331


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What’s driving the increases?Complexity Drives Higher Implementation and Support Cost

Medical Devices

Networked Systems

System Integration

Features Sold as “Value Added

Capabilities” often drive cost for

Implementation and Support

Complex

Simple

C o m p l e x i t y

Total Cost

Trends:

Increasing Customization Options

Software Subscription Model

Wearable & Disposable sensors

Trends:

WAN Functionality

Customer Supported Network

Mobile & Wireless Use Cases

Trends:

System/System Bi-Directional

Automated Workflows

Business Intelligence


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Planning

Install

VendorSupport

Parts &Consumables

PurchasePrice

IT/CE Support

Security Infrastructure

ClinicalFunctionality

TrainingRequirements

Upgrades

DataIntegration Costs less Commonly

Managed by Sourcing

Teams

More Specialized

Resources required to

Assess

Commonly Evaluated

and Negotiated by

Sourcing Teams

Costs

RelativelyStable

Source of

Spending

Increases

What’s driving the increases?

Acquisition Cost is Only the Tip of the Iceberg


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Technology AcquisitionsImpact from Discrete (one patient one device) to Enterprise

Across

Continuum

of Care


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A Structure for Making Effective

Clinical Technology Acquisition Decisions


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Healthcare Technology Assessment Committee

To address the challenge of identifying healthcare

technologies for acquisition, this organization should

establish a Healthcare Technology Assessment (HTA)

Committee


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Rationale for HTA Committee

increasingly new technologies are having a ripple effect on an

organization’s clinical, support, and business operations

new technologies can also have a major impact on the

organization’s financial resources.

growing need to give appropriate consideration to the strategic,

clinical, safety, operational, and financial implications prior to

acquisition


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HTA Committee Purpose

take a strategic view

focus on evidence-based consideration of technology acquisition

engage appropriate stakeholders ... including those who

understand how to analyze and plan deployment and workflow

processes can identify required support infrastructure & associated costs

establish appropriate justification process & metrics relevant to

organization’s goals


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Example of HTA Committee Structure

Multidisciplinary team (with ad-hoc representation):

Department Chairs/Directors (owner/operators of equipment)

Chief Medical Officer (CMO)

Chief Medical Informatics? Officer (CMIO)

Chief Nursing Officer (CNO)

Chief Executive or Operating Officer (CEO/COO)

Chief Financial Officer (CFO)

Director of Supply Chain / Materials

Director of Healthcare Technology Management / Clinical Engineering

Chief Information / Technology Officer (CIO/CTO)

Additional committee support staff includes senior experts in information

services, quality, compliance and risk management.


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LeadershipTeam

CEO

COO

CTO

CMO

CFO

Clinical

DepartmentChairs/Managers

Clinical EndUsers

MedicalInformatics

Technical

ClinicalEngineering

InformationTechnology

Supply Chain

Finance

Financial Analylst

Revenue Cycle

Property Accounting

Sourcing,

Risk &Quality

Sourcing

Quality

Compliance

Risk Management

Legal

Example HTA Committee Structure


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Leadership

Team

Defines Strategy,Goals & Objectives

Allocates

Resources toCommittees

Ensures BalancedDecision Making

Approves

Contracts &Expenditures

Clinical

Defines ClinicalNeeds &

Opportunities

Provides Clinical

Workflow & EndUser Expertise

Defines ClinicalTraining

Requirements

Champions PatientPerspective

Technical

Forecasts & Plansfor New

Technologies

Defines TechnicalRequirements

AssessesCapabilities &Value-Adds

Defines Installationand Support

Strategy

Provides Inventory& Cost of Service

Data

Finance

Analyzes andValidates Financial

Benefits & Risks

Manages &

Reports SpendForecast

Supports year-over-year

investment strategy& budgeting

Sets Metrics to

analyze HTAperformance

Sourcing,Risk &

Quality

Manages VendorEngagement,Negotiation,Compliance

Provides Risk and

Quality data foranalysis

Ensures adherenceto policy,

regulations andrequirements

Advises on Risks &

BusinessContinuity

Example HTA Committee Roles

Champion Implementation of Strategies


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HTA Committee Goals & Metrics

The HTA committee considers goals and establishes metrics that

can demonstrate progress to goals. Examples of goals include:improved care outcomes

improved patient/staff safety

reduced data security risks

improved regulatory compliance

improved efficiency & workflow processesimproved revenue, particularly improvements with P4P initiatives

reduced costs

improved technology reliability

improvements in utilization & longevity

greater technology & vendor standardization to reduce support costsbroader patient demographic served

improved market perception (reputation)


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A Process for Making Effective



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The Acquisition Process

The Joint Commission Comprehensive Accreditation and

Certification Manual (EC.02.04.01, EP1)“The hospital solicits input from individuals who operate and service equipment

[e.g., HTM/CE services, IT] when it selects and acquires medical equipment .”

Acquisition process should be systematic & meaningful …

the acquisition process should consider

is proposed equipment new or replacement?

does similar equipment already exists in organization?

who and what areas will be affected by acquisition?

what goals are to be achieved by the acquisition and how is

successful achievement of those goals to be measured (metrics)?


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The Acquisition Processprospective owner

submits a request for new

(or replacement equipment)

along with justification to

COO/CFO for preliminary

approval

if preliminary approval given by

COO/CFO, request/justification form

is submitted to HTA committee

HTA committee conducts an

appropriately detailed assessment

of request & justification, evaluates

the degree to which the requested

equipment meets one or moreorganizational goals and makes

recommendations to the COO/CFO


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The Acquisition Processif an acquisition is approved by the

COO/CFO, materials management

/supply chain works with users,

HTM/CE services and other relevant

stakeholders (e.g., IT, facilities) to

establish an acquisition timetable

determine detailed requirements

(to be incorporated in RFP

purchase order) and

evaluate/select the product and

vendor (thru RFP)

the selected vendor is given an order

including established

specifications/requirements

roles & responsibilities for deployment,

installation, workflow design, training &

support are detailed & formalized


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Tools for Making Effective



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Key Acquisition Tools

Capital Medical EquipmentRequest & Justification Form

Acquisition Requirementsfor Medical Equipment


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Medical Equipment Request and Justification Form

Requestor InfoProduct & Vendor Info

Description, Manufacturer, Model, Cost?

Does other equipment from this manufacturer & model already exist?

If yes, how many & where?

Vendor

name

is this vendor already vetted?

is this vendor a participant in one of organization’s group purchasing organizations?


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Funding SourceOther Initial Costs Beyond Acquisition

(estimated)

additional staff

operator training

maintenance training

facility modifications

additional equipment

Projected Annual Costs maintenance (post warranty)

software upgrades/ license fees

supplies & Consumables

utilities (electric, water, gas,

network, etc.)

operators & operator support …

including cost of on-going user

training


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New equipment?

Does new equipment

provide new (or expand existing) service or provide needed new features?

facilitate patient care and/or workflow improvements?

provide important safety improvements?

other justifications?

Will there be a sufficient amount of utilization to support its acquisition and allowfor user proficiency to develop? Users get good at what they do frequently

(practice or live).


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Replacement equipment?

Does the existing equipment

have insufficient features/functions

for current or projected clinicalneeds?

have insufficient capacity foranticipate workload?

have unresolvable safety issues?

technically unreliable?

too costly to support?

approach clinical and/or technical

obsolescence? approach end of manufacturer

support?


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Other considerations – Are there

special data security needs?

monitoring needs (important alarms/alerts)?

space needs?

environmental needs?

special utility needs?

network or internet access needs?

special cleaning or infection control needs?

appropriate guidelines for alarm/alert settings

di l i d ifi i


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Metrics

description of principal benefit(s) of acquiring

equipment

projected utilization

description of timetable for achieving benefit(s)after acquisition?

description of means to measure benefits gained

Pillars

service

people

quality

financial

growth

community

M di l E i R d J ifi i F


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Required reviews /sign-offs … does the proposed system

require a network or internet connection, software, integration to EMR?

represent a device/system used in treatment, diagnosis or monitoring?

represent a device/system that either is new technology or has a broad effect on care?

requires installation, facility modification, special environmental considerations, utilities?

R i t f A i iti f M di l E i t


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Requirements for Acquisition of Medical Equipment

Next 3 slides should be considered “minimum” requirements

….

...



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Minimum requirements for warranty service documentation

...



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Signed/agreed to by vendor … and stakeholder who will be

responsible for verifying compliance

…. ...

P t A i iti Cl th L


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Post Acquisition - Close the Loop

Review the justification & metrics 6 -12 months after acquisition

in order to inform and refine process

C l i


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Conclusion

Sophistication, Complexity and Broad Impact (operational &

financial) of today’s clinical technologies on an organization is

too significant not to include informed stakeholders in theacquisition process and decision

Strategic, systematic, objective evidence-based approach with

input from informed stakeholders needs to be norm for future

clinical technology acquisition decisions


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Conclusion:Rationale for Investing in Healthcare Technology Assessment

MedicalTechnology

Lifecycle

Vision-

StrategyPolicy

Assessment

Plan – Design-Budget

Acquire – Procure

Build-Deploy

OperateMaintain

Refresh – Redeploy –

Retire/

Ensure Acquisitions align with

Organizational Strategies andFinancial Goals

Evaluate Technology Capabilities,Benefits, Risks and RiskMitigation strategies.

Understand Impact to Clinicaland Business Workflows

Understand infrastructure andresource needs to achieveBenefits Realization

Define Implementation and

Ongoing Support Requirements

Balance Total Cost of Ownershipwith Business and Clinical Needs


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Thank You!

Questions?

Stephen L. Grimes, FACCE FAIMBE FHMISSChief Technology Officer,Healthcare Technology Management DivABM Healthcare Support [email protected]

(617)756-9088

Jacob B Johnson, MS CCEManager, Clinical TechnologyIntegrated Systems Management

Kaiser [email protected] (510)414-2435)
mailto:[email protected]:[email protected]://healthy.kaiserpermanente.org/html/kaiser/index.shtmlmailto:[email protected]:[email protected]

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